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Hepatic cystic lesion in adult: a challenging diagnosis of undifferentiated primary embryonal sarcoma

Casistica clinica, 225 - 228
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Summary: Hepatic cystic lesion in adult: a challenging diagnosis of undifferentiated primary embryonal sarcoma.
M. Massani, E. Caratozzolo, M. Baldessin, L. Bonariol, N. Bassi

Cystic lesions of the liver are common. Most of these represent benign simple cysts that generally require no intervention. The diagnosis of simple hepatic cysts is straightforward in the face of typical radiographic findings; however, diagnostic uncertainty, based solely on radiographic criteria alone, is not an uncommon clinical dilemma.
In this report, we present a case of a 47 old woman with a cystic liver lesion and acute epigastric pain. The patient had no previous history of oral contraceptive assumption or liver disease. A tender mass was palpable on the upper right quadrant of the abdomen.
The abdominal ultrasound (US) showed a cystic lesion with a possible hemorrhagic component on right liver lobe. Abdominal computed tomography (CT) and magnetic resonance (MR) revealed a complex cystic lesion with possible intracystic hemorrhage.
The patient was submitted to operation and resection; the final histologic diagnosis revealed a primary undifferentiated embryonal sarcoma of the liver.
She relapsed 24 months after a new hepatic resection and chemo-embolization, she is alive at 29 months after first surgery.

Versione italiana
Riassunto: Lesione cistica epatica in adulto: un caso di difficile diagnosi di sarcoma embrionale primitivo indifferenziato.
M. Massani, E. Caratozzolo, M. Baldessin, L. Bonariol, N. Bassi

Le lesioni cistiche del fegato sono comuni. La maggior parte di esse rappresentano semplici cisti benigne che non richiedono alcun intervento. La diagnosi di cisti semplice si ottiene con la ecografia o la TC. Tuttavia, qualche volta vi è un’incertezza diagnostica che pone dilemmi clinici.
Riportiamo il caso clinico di una donna di 47 anni con una lesione cistica del fegato riscontrata dopo un violento dolore epigastrico. Non vi era storia di contraccettivi orali ed era apprezzabile una tumefazione dolente in ipocondrio destro.
L’ecografia, la TC e la RM hanno rilevato una lesione cistica complessa del fegato a contenuto emorragico.
La paziente è stata sottoposta a resezione epatica e l’esame istologico ha dimostrato trattarsi di sarcoma embrionale primitivo ed indifferenziato del fegato che è recivato dopo 24 mesi.
Sottoposta a nuova resezione e chemioembolizzazione, la paziente è viva a 29 mesi dal primo intervento chirurgico.

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